Tinchon Alexander, Mikšová Dominika, Lang Wilfried, Krebs Stefan, Freydl Elisabeth, Baumgartner Christian, Friedrich Oliver, Oberndorfer Stefan, Sykora Marek
Karl Landsteiner University of Health Sciences, Krems, Austria.
Division of Neurology, University Hospital St. Pölten, St. Pölten, Austria.
Eur Stroke J. 2025 Jun 19:23969873251341770. doi: 10.1177/23969873251341770.
Posterior circulation (PC) stroke is underrepresented in most large-scale trials. While the importance of the onset-to-needle time (ONT) for intravenous thrombolysis (IVT) in anterior circulation stroke is well established, data on PC stroke are lacking. This study aimed to investigate how ONT affects functional outcome after IVT and to identify additional predictors of outcome in PC stroke.
IVT-treated PC stroke patients included in the nationwide Austrian Stroke Unit Registry between 2003 and 2024 were retrospectively analyzed. The primary outcome measure was the excellent (mRS 0-1) and non-excellent (mRS 2-6) functional outcome at 90 days. The secondary outcome measure was the occurrence of severe intracranial hemorrhage (sICH). Associations between ONT as continuous variable, clinical predictors, and functional outcomes were assessed using ordinal and binomial logistic regression models. A cut-off point for the transition from excellent to non-excellent outcome was determined by maximizing the odds ratio metric. The effect of ONT on sICH was analyzed dichotomously in time intervals of 0-150 min and 151-300 min.
Of 11,025 eligible patients with PC stroke, 1,359 (12.3%) were treated with IVT, resulting in more frequent excellent functional outcome in patients treated with IVT compared to best medical treatment (BMT) in the ordinal logistic regression (adjusted odds ratio (aOR) 1.31, 95% CI 1.16-1.47, < 0.001). Correspondingly, binomial logistic regression showed fewer non-excellent functional outcomes in patients treated with IVT compared to BMT (aOR 0.73, 95% CI 0.63-0.85, < 0.001). The odds of an excellent functional outcome were increased within the first 282 min, with a pronounced treatment benefit in the first 122 min. The transition cut-off point was found to be at 258 min. sICH occurred in 2.8% and was unrelated to ONT (aOR 1.28, 95% CI 0.55-2.91, = 0.552). Overall, women had lower IVT rates (11.3% vs 13.0%, = 0.007) and were more likely to experience a non-excellent outcome (aOR 1.31, 95% CI 1.19-1.45, < 0.001), but had similar functional outcomes compared to men when treated with IVT (aOR 1.03, 95% CI 0.74-1.43, = 0.883).
A treatment benefit of IVT in PC stroke was observed within 4.5 h of stroke onset, with its maximum within the first 2 h. Women should receive special attention as they may be at a prognostic disadvantage due to lower IVT rates and less favorable overall outcomes.
在大多数大规模试验中，后循环（PC）卒中的比例较低。虽然前循环卒中静脉溶栓（IVT）的就诊至穿刺时间（ONT）的重要性已得到充分证实，但关于PC卒中的数据却很缺乏。本研究旨在探讨ONT如何影响IVT后的功能结局，并确定PC卒中结局的其他预测因素。
对2003年至2024年间纳入奥地利全国卒中单元登记处的接受IVT治疗的PC卒中患者进行回顾性分析。主要结局指标是90天时的良好（改良Rankin量表[mRS] 0-1）和非良好（mRS 2-6）功能结局。次要结局指标是严重颅内出血（sICH）的发生情况。使用有序和二项逻辑回归模型评估作为连续变量的ONT、临床预测因素与功能结局之间的关联。通过最大化优势比指标确定从良好结局转变为非良好结局的临界点。在0-150分钟和151-300分钟的时间间隔内对ONT对sICH的影响进行二分法分析。
在11,025例符合条件的PC卒中患者中，1,359例（12.3%）接受了IVT治疗，与最佳药物治疗（BMT）相比，IVT治疗的患者在有序逻辑回归中获得良好功能结局的频率更高（调整优势比[aOR] 1.31，95%置信区间[CI] 1.16-1.47，P<0.001）。相应地，二项逻辑回归显示，与BMT相比，接受IVT治疗的患者非良好功能结局更少（aOR 0.73，95% CI 0.63-0.85，P<0.001）。在最初282分钟内，良好功能结局的几率增加，在前122分钟内有明显的治疗益处。发现转变临界点为258分钟。sICH发生率为2.8%，与ONT无关（aOR 1.28，95% CI 0.55-2.91，P = 0.552）。总体而言，女性的IVT率较低（11.3%对13.0%，P = 0.007），更有可能出现非良好结局（aOR 1.31，95% CI 1.19-1.45，P<0.001），但与接受IVT治疗的男性相比，功能结局相似（aOR 1.03，95% CI 0.74-1.43，P = 0.883）。
在卒中发作4.5小时内观察到IVT对PC卒中的治疗益处，在最初2小时内最大。女性应受到特别关注，因为由于IVT率较低和总体结局较差，她们可能在预后方面处于不利地位。
